Monday 25 October 2010

Sound Advice

A long time ago I promised to set out the implications of the new UK government’s policies for people with a serious mental illness. The delay is not due to my indolence but because it has taken a long time to get a fix on what will really change and in fact the full implications are still not clear.

The Assembly Government’s overall budget has been set but we await details of how they will prioritise. In practice I suspect that they will in any case not prescribe priorities in enough detail so that we will still have to await the decisions of the NHS Local Health Boards and local authorities about priorities and funding for mental health services.

But we are getting more details on benefits and can begin to see the changes which will be experienced by individuals with a serious mental illness. For a simple summary of the proposals with links to more detail follow this link.

For all that there will be pressure on mental health services (and for some individual users of services this may be the most important matter) it is now clear that for most people with a serious mental illness the key concern must be changes to the benefits system. Even before the recent announcements Hafal has had contact with many individuals who have fallen foul of the substantial changes both to the rules and practice relating to Employment Support Allowance. In particular we have witnessed what amounts to oppression of some individuals with serious mental illness who are simply unable to work but have had their delicately-balanced lives disrupted by repeated reviews which fuel anxiety and paranoia in a wholly counter-productive way.

The announcements last week, not least the restrictions on housing benefits for people under 35, add to an anxiety that the principle of assuring a reasonable standard of living for all people with a serious mental illness may be under threat. However, the main issues seem to me still to lie in the rules, culture and interpretation of the system and the jury is still out on whether Iain Duncan Smith can find an approach which genuinely still provides for people with serious problems while meeting his ambitions both for cost-cutting and incentives to get people into work.

I’m not optimistic about this. The trouble is that there is a consensus about wanting rules which will not victimise people with a serious mental illness but nobody has found a way to ensure that the proper concern to expose inappropriate claims of disability and need does not lead to injustice and oppression. And the consequence of mistakes, even if cleared up later, are much greater for people with a mental illness because of the terrible irony that applying pressure to get people back into work can actually make them more ill, and therefore less likely to go to work.

In campaigning terms I cannot see common cause with a position which seeks to protect all present practice in relation to benefits. To do so is to invite the government to ignore what we have to say. An example of this is the Western Mail’s leading article following Iain Duncan Smith’s suggestion to unemployed people in Merthyr that they travel to Cardiff for work. The paper seemed to suggest that it was unreasonable to expect people to catch a bus at 7.55 am to go to work. I will not pass judgement on this but surely such an expectation stands no comparison with applying pressure and threats to the income of vulnerable and lonely people with florid schizophrenia, for example: we need to open the government’s eyes to those people’s needs – and to open the eyes of the likes of Atos Origin, the contractor which is reviewing ESA clients for the government and making a dog’s breakfast of far too many cases.

Hafal will certainly take up the challenge and we are already engaging with DWP to try to establish good practice in reviewing cases. We have also assisted hundreds of our clients this summer through our “Ease the Squeeze” campaign which included advice on ESA.

Patients may feel disempowered and frightened by the changes but I would strongly encourage them to take some control by seeking to establish where they personally stand, even if they have not so far experienced any change. You could do worse than visit your Citizens Advice Bureau or other advisor to check out how you might be affected and consider how you will respond to review and change. I’ve said before that the vital advice is to get help before responding to review processes. The clue to getting the right results is to engage both with a benefits specialist such as the Citizens Advice Bureau and also with a mental health organisation which understands your illness – and you need to involve your care coordinator, doctor or psychiatrist, making sure they understand the implications of what they may write or say on your behalf.

Postscript: nearly thirty years ago I worked for the CAB broadcasting snippets of advice on Swansea Sound. It was my first proper job after university and we had a lot of fun as well as benefiting from the CAB's matchless training. For shame I also recollect that there was a competition among us to see how much anxiety we could cause for the rather self-important disc jockeys who were super-sensitive about not upsetting their mainly female and middle-aged audience. I won by graphically describing on air certain grounds for divorce then still in statute which wouldn't raise an eyebrow today but sent the poor jock into apoplexy, gurning and gesticulating silently at me to stop, which I didn't of course. Happy days.